New on Lantus - Vet just bumped to 2 units. Too soon? Monitor overnight?

Toonces Mom

Toonces Mom

Member Since 2018
My cat was diagnosed last week - no DKH; picked up on blood test (BG 410) after taking him in for some outside of the box thinking....

Vet started him at 1 unit Lantus bid. Told me to test pre-shot but I tested extra mid cycle after reading on this board. Sent vet my test chart Mon and she told me yesterday to increase to 2 units. His +2 tonight was 175. After reading here, I’m concerned we are increasing too fast. I gave him 2 units this morning and 2 units tonight — should I monitor with BG tests overnight? If so, how often? Feeling overwhelmed, worried about hypo event, and just want to do what’s right for my sweet boy. P.S. not sure if it matters for dosage but he’s a big cat- currently 14.5 pounds and his “healthy” weight is 18 according to vet.
 
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We don't ever recommend increases by whole units.....cats are small and small changes can make big differences.

We recommend doing changes by .25 unit only

You also need to make sure to always get at least 1 test on the PM cycle...most cats go lower at night so it's important to get a "before bed" test on the PM cycle to make sure they're going to be safe while you sleep.

You also are missing half the data by not testing on the PM cycle.

Does Toonces drive?.....LOL
 
Chris & China said:
We don't ever recommend increases by whole units.....cats are small and small changes can make big differences.

We recommend doing changes by .25 unit only

You also need to make sure to always get at least 1 test on the PM cycle...most cats go lower at night so it's important to get a "before bed" test on the PM cycle to make sure they're going to be safe while you sleep.

You also are missing half the data by not testing on the PM cycle.

Does Toonces drive?.....LOL
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Thank you- this is very helpful. I’m very frustrated with my vet for just telling me to test pre-shot as I will do whatever needed to treat him best and would have been testing! I will monitor him overnight and be prepared with my honey, etc if needed (hopefully not...ugh).

Name was my husband’s choice lol. And right now, he’s for sure driving this house and my life with this diagnosis!
 
Lots of vets make this mistake. Mine was the opposite and moved too slow. At first I thought why would I trust stangers over my vet. I soon learned the answer was that people here know more than many vets. Most listen to their vet but not their advice when it feels wrong.
 
Follow up question...what’s a before bed read where you can feel comfortable that your cat will have a safe sleep? I imagine there’s not one answer but my guy’s numbers have been so reliably in the 300s that even a 175 makes me nervous to go to bed! I’m willing to wake up every 2 hours overnight if that’s what it takes - but I need some ammo to convince my husband that’s necessary since I still struggle at testing Toonces alone. Thanks!
 
That's a pretty significant drop for so early in the cycle.....I'd plan on getting at least a +4 and it's possible you may need to get another test in later

The +2 has some unwritten rules here (although for some cats, the +3 is a better predictor)

If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually up by the next PS

If the +2 is higher than the PS, that's usually a sign that a bounce is starting and it means you can probably get by without doing more testing later

If the +2 is lower than the PS, that's your "early warning" that they may be going a lot lower later in the cycle.

Lantus usually starts to "kick in" somewhere between 2-3 hours after the shot....so to see such a big drop so early, I'd plan on getting at least 1 more test in
 
Thanks. He came around wanting to finish his food and ate a little bit an hour ago. Just tested again and he’s at 178 +3.5. I’ll test him overnight - is every 2 hours good?
 
Toonces Mom said:
I’ll test him overnight - is every 2 hours good?
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You (hopefully) won't need to test him all night....he's not dropping as fast as he was, so you could probably take a nap and set an alarm and get a +5

If he's still surfing in very safe numbers, you could call it a night at that point.
 
Toonces Mom said:
Thank you! This is so stressful when starting out!
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Ok. So I tested him last night and he was 226 at +6. Then this morning AMPS was 239, so I gave him 2 units, then +5 was 373! And now +8 is 179. I’m so confused — is this what people refer to as bouncing? Does it mean the 2 units is too high?
 
It's totally normal for them to have really wonky numbers at first.....It was a good 4-5 months before China settled into what I'd call any kind of "pattern"

Since you've started the 2U dose, we might as well see how he does on it now.

You'll need to hold the 2U dose for at least a total of 6 cycles.

We also need for you to be reading the 2 dosing methods we use here. Tight Regulation offers the highest chance at remission, but generally needs more frequent testing. Start Low, Go Slow also has it's success stories, but not as often.

With TR, you can raise the dose as often as every 6 cycles if it's not getting them where you want whereas SLGS has you hold the dose for at least a week.

TR requires a low carb canned or raw diet ONLY....No dry food.

What kind of meter are you using? The AlphaTrak? Would you please add that to your "signature"?
 
Thanks. I will review the dosing methods— I have just been relying on my vet for the dosing. She said she wants him to be “tightly regulated” but I don’t know what method she’s actually using. Using AlphaTrak and only feeding Purina DM. His PMPS tonight was 319.
 
It sure would be nice if could rely on our vets, but the sad truth is that they only get 5 hours of diabetes education when they're in school and that covers both dogs and cats.

Once they're in practice, they just don't have the time to stay up to date on the latest research and protocols.

Yes, they have to take CE but CE courses are chosen by the participant.....so if a vet chooses to learn more about diabetes, they usually go with canine diabetes because they see more diabetic dogs than cats. (although cats are catching up!)

That's why this board is so good....the people here have years of real life experience as well as the time to stay up to date on the latest treatments on diabetes and the diseases that tend to come with it.

My own cat hasn't been back to a vet for her diabetes since she was originally diagnosed over 5 years ago. I drank the FDMB Kool-Aid early.....LOL

But seriously, I have always felt that "real life" learning was more important than "book-learning", so when I found out how much experience the people here have, I just trusted them.

It would be great if our vets were open to learning along with us, but unfortunately, most of them won't admit they don't know everything. I'd personally feel better about a vet that said "I don't know but let's learn together" than one that just dictated "Do this and call me in 2 weeks".

There are a few "good ones" out there though and I hope yours is one of them!
 
Thanks for this info. Unfortunately I recently switched vets so I don’t have enough experience to fully trust her or not! But she is young and seems very open to learning with me. She admitted she needed to study up on the most recent feline diabetes guidelines and has pushed at home testing very hard (which seems the right approach). I’m a lawyer so I’m self-reliant and skeptical/critical (of everything) by my nature! I’ve also got a very tight schedule and travel often so I’ve got to be laser focused on finding a dosing method and management plan that will work for us and our sweet boy. It seems that will need to include a skilled cat sitter(s) so I’m working on finding someone we can incorporate into and educate on our treatment plan. Any recommendations in ATL are welcome!
 
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